


My Extra Heart

by Dawnwind



Category: The X-Files
Genre: F/M
Language: English
Status: Completed
Published: 2011-04-08
Updated: 2011-04-08
Packaged: 2017-10-17 18:11:07
Rating: General Audiences
Warnings: Creator Chose Not To Use Archive Warnings
Chapters: 1
Words: 3,259
Publisher: archiveofourown.org
Story URL: https://archiveofourown.org/works/179744
Author URL: https://archiveofourown.org/users/Dawnwind/pseuds/Dawnwind
Summary: <blockquote class="userstuff">
              <p>Missing scene from Brand X</p>
            </blockquote>





	My Extra Heart

Asheford Medical Center, six p.m.

 

My heart is painful as an open wound when I walk into Mulder's hospital room. I've just seen his x-ray after the awful ordeal of the deep suction. His pulmonary tissue is  
riddled with the terrible beetle's egg infestation. What do I tell him? How to explain that medical science has no idea how to cure him? I curve my fingers around his long, limp hand and his eyes open, searching my face.

"Must be bad." He can barely talk, his voice both rough and fragile, his throat ravaged by the deep suction tube that had been forced down his trachea.

"How do you feel?" It's an inane question. He looks terrible, his eyes like dull holes burned into a white sheet, but he gives me a half smile, trying for my sake.

"Like a dust buster attacked me." He coughs raggedly.

"We're looking for someone who may be able to help you," I explain, trying to smile for his sake. "An unwilling test subject by the name of Darryl Weaver." Can he see my fear? That I'm afraid he'll die while I stand by useless?

"Oh." Mulder coughs, then waggles his head, indicating he knows who Weaver is. "Mr. E. Pluribus..."

"Well, Mr. Weaver seems to have some kind of tolerance or immunity and we're hoping that once we find him we'll be able to figure out how to treat you."

Mulder opens his mouth to speak, but gasps for breath, looking imploringly at me. He takes another breath, a high pitched squeak issuing forth. He heaves like an asthmatic,  
desperate for oxygen, his face beginning to panic. I can feel my own breath catch as he's struggling to draw a breath, each inhalation more labored than the one before.

"Mulder?" My eyes are drawn to the heart monitor above the bed, the beeps signaling increasingly dangerous levels.

According to the flashing green numbers, the oxygen saturation in his blood has already dropped below 90, and shows no signs of stopping its descent. "Doctor!" I call, looking for the oxygen mask hanging on the wall behind the bed. I can't just let him die.

Doctor Silverman runs in, his stethoscope bouncing on his chest. He gets the earpieces into his ears in record time, pressing the bell against Mulder's heaving chest.

"His sats are down to 72, get some O2 on him and call a code," I order rapidly, still fumbling to get the green plastic mask ready for my partner, but my hands are unsteady and it isn't until the nurse, Susan, rushes in, pushing the code cart with her that the mask is placed over his nose and mouth. One hundred percent oxygen doesn't help his saturations one iota.

Mulder's heart is racing, the monitor numbers accelerating with frightening speed. His cardiac muscles are spasming as the oxygen content in his blood decreases. His blood pressure increases to try and force more blood into the heart, but it's doomed to fail.

The nurse prepares the defibrillator with competent speed, switching on the paddles in anticipation of the code blue. Mulder is already near unconsciousness, the extra oxygen from the mask pumping vital gases to support his dying cells. I lean over to comfort him, feeling powerless against his unrelenting decline, then recoil as a beetle climbs over Mulder's lip, out of his mouth. It remains there, trapped by the green plastic mask.

"He's in V-fib," Doctor Silverman warns, the defibrillator paddles placed into position on Mulder's naked chest.

"Clear!" he calls and the two nurses move back from the patient. Silverman watches the jagged green line on the monitor, identifying ventricular fibrillation, a heart out of control. Mulder's heart is beating so fast that blood isn't pumped through the chambers, instead pooling in the flailing cardiac muscle, useless to the rest of the body.

The doctor sends jolts of electricity through the defibrillator paddles, Mulder's body jerking spastically off the bed. It takes a second, higher voltage to get his heart rate  
back into sinus rhythm, the heart beat necessary for life.

My own heart rate is racing so fast I'm light-headed, hands shaking so I let the nurses get out the equipment needed to intubate Mulder. I want to help, but I'm momentarily paralyzed with fear for his life.

Dr. Silverman slides the tube down my partner's throat, having to stop three times to suction beetles from his mouth and nose. It turns my stomach and I force myself  
not to look away.

"This is only a stop-gap." The doctor rubs his nose where his glasses pinch, frowning. Mulder is now connected to the ventilator, but it hasn't improved his saturations. "There's too much clogging his airways. We're never going to get adequate ventilation."

As if to prove his point, Mulder's arterial blood gas starkly illustrates the ventilator's ineffectiveness. A blood gas is the measure of the levels of oxygen, carbon dioxide and  
other gases necessary for proper respiration. The numbers show his blood is woefully under oxygenated and adjustments have to be made to the machine. The breath rate is increased, Mulder's lungs mechanically inhaling and exhaling with maximum force.

"What else do you suggest?" I ask, unable to tear my eyes away from my partner's pale face. My hand reaches down to push back the lock of hair falling across his forehead, lingering for a moment. He doesn't respond, he's been pavulonized, given the drug Pavulon to keep him in a paralyzed state so he won't fight the ventilator. The drugs Versed and Morphine will insure he doesn't remember anything or feel the pain in his chest. There's no drug that will stop the maturation of the eggs buried in his lung tissue.

I'm no expert in pulmonology but I know we're nearing the end of our options. If a patient can't oxygenate, his brain cells will die, his heart will stop and he will cease to live. I  
can't let that happen. "What else is there?" I question the doctor.

"ECMO." The word lies bare between us, ugly and frightening.

ECMO. Extra corporeal membrane oxygenation. Some people might call it a heart lung machine. It mechanically oxygenates the blood outside the human body, to take the place of damaged, diseased lungs. A desperate measure, but I cling to it like a lifeline. Mulder's life.

"Do it."

X-rays taken while the surgical team prepares confirms our worst fears. Mulder's chest is crawling with larvae, and it's imperative that we get him connected to the ECMO as soon as possible. There seems to be no way to stop the tobacco beetles from strangling off his airways and choking the life out of him.

I yearn to be able to help, but here I have no experience. I've only read about the procedure and watch with terrified fascination. At best, it still will only be a palliative  
measure. I need to discover a means to rid his body of the infestation.

Blue masked and gowned surgeons operate quickly, their skilled movements delicate and precise. First, an incision is made into the neck, the pulsing carotid and nearby jugular visible, containing the blood coursing to Mulder's brain. The surgeon inserts a huge catheter, carefully threading the tube down into the subclavian vein, then suturing it into place. That tube is connected to more tubing snaking across to the hulking  
behemoth of the ECMO circuit. The plastic tubing looks barbaric and painful, sticking out at an angle from Mulder's neck like an extra appendage.

A conventional ventilator still pumps his lungs in and out with mechanical breaths, but once the ECMO circuit is switched on, dark red blood begins to drain from the body through the catheters into a revolving cylinder. The blood is filtered through the system, carbon dioxide removed and life giving oxygen substituted. Bright red blood is then pumped back into the body via a second tube, flowing into Mulder's arteries to sustain life. It's terrifying and amazing to watch the two tubes, the color of their contents so different, and yet containing the same scarlet fluid.

I hesitantly touch the tubing. It is warm against my palm and sways slightly from my touch. A lifeline hanging between Mulder and the ECMO machine like a rope bridge between heaven and Earth.

One nurse tends my partner, and another the complex pile of computer monitors, gauges, filters and tubing that comprise ECMO. I feel out of place and useless, and there's too much activity around Mulder's bed for me to sit quietly beside him.

He is alone; a pale, drawn face above the plastic tubes, surrounded by technology alien to me. I am impotent, unable to help and I feel ashamed. What use was my medical degree? The man my heart beats for lies near death and I can only stand idly by, an observer.

 _Keep breathing, Mulder._ That's all you have to do.

I obsessively scan the results of each blood test, needing to know every blood gas, lab value and x-ray by heart, as if possession of these numbers and images can help Mulder. The knowledge sustains me, but it's increasing devastating. Mulder's body is failing.

Stepping outside of the room, I spot Dr. Silverman. I know he's been down in radiology to get the latest x-rays, but he doesn't look hopeful. I take a deep breath, trying not to let  
others cause me to lose faith. Mulder's beaten the odds before, we just haven't looked in the right place yet to find the answer.

"Dr. Scully?" The bespeckled man approaches. "We've got him stabilized on ECMO for the moment, but we won't be able to maintain him on it for long." He holds up a horrible film of Mulder's lungs, the larvae plainly visible throughout both lungs, and congregating in the main bronchus like invading armies. "’Course you can see why."

"There's more now than there were six hours ago." My voice trembles just slightly, but I feel icy inside. How can Mulder survive this? What can we use to fight back? It's like the  
little Dutch boy with his finger in the dyke, there's no stopping the flood. All we've done is slow it down.

"They're beginning to block to flow of blood. Our best bet is to go back in there," the doctor continues, his face grave. "I think this time we have to crack the chest."

"No!" The words slip from my mouth. "He's too weak for thoracic surgery. He'll die on the table."

"I don't know what our other options are."

"I'd say, for the time being, just wait," I insist. Sometimes we need to slow down, to see the obvious answer. We've been barreling along so fast, trying to rid his body of the  
beetles, and it hasn't worked. There must be a different approach, I just need to figure out what it is before it's too late.

"And that will definitely kill him, sooner or later," Silverman intones with a shake of his head.

I turn my head to watch the nurses hovering over Mulder. It's a relatively quiet moment. There are no beeping alarms, no frenzied rushing around. The blonde nurse gently pulls the blanket up over my partner after checking his IV line and I wish it were me touching his hand, his lips, leaning over to caress his forehead. We only recently took the next step, to establish a real relationship outside of the work area. This can't be how it ends.

Time seems to creep. I know that Assistant Director Skinner is pulling out all the stops to find this Darryl Weaver, but he wasn't at his home. Instead they found yet another man dead from the super tobacco beetles, his mouth filled with the vile little bugs. I recall from some back corridor of my exhausted brain that the Egyptians once revered beetles, believing they contained a person's soul. Scarabs are sacred religious fetishes carried by many people. My brother even brought one for me after a boat ride on the Nile. I don't think I'll be able to look at another beetle ever again.

Just when sleep has finally taken over my senses, there is a phone call at the nurses' desk. Paramedics are bringing in Darryl Weaver. He's been shot in the shoulder, but will live. My heart pounds even before I dash down three flight s of stairs to the E.R.

This could be Mulder's last hope. If Weaver's blood contains some sort of immunity against the beetles, we may be able to construct a vaccine. The question is how long will that take and will it actually work once injected? These are questions I don't even want to dwell on. I want hope. I have faith. Mulder still breathes and this buoys my spirit above the negative fears of his medical team.

The double doors to the ER burst open as the paramedics rush the patient in. He's a skinny, scruffy looking man with a bloodstained left shoulder. I hardly even glance at his wound. I just want answers.

"How's Mulder?" Walter Skinner asks breathlessly, following closely behind the gurney.

"Not good," I admit, mentally preparing what I need to have done. "I want some blood work on this man," I command. I know what to do in an ER. I feel powerful here, able to make a difference.

Doctor Silverman begins to gather up supplies for the blood draws as I pick up one of Weaver's hands to find a vein. His fingers are thick and heavily stained, the skin yellow almost all the way to the knuckles.

It's like I've been kicked in the gut. I found the answer, staring me in the face all along. "Wait a minute. Give me thirty milligrams of methyl-pyrrolidinyl-pyridine."

"Nicotine?" the doctor translates.

"Yeah." I smile triumphantly, looking with real hope over at Assistant director Skinner. "I think this could save Mulder's life."

It does, but just barely. Nicotine is a powerful drug, highly addictive. But it is also toxic to beetles, a very effective form of insecticide. Mulder's body, already ravaged by  
the beetles, barely survives the caustic effects of the enormous dose of nicotine he's given. His heart stops briefly and has to be shocked once again with the defibrillator. I can't even watch this time. We already know the beetles are dying when Mulder  
briefly joins them. After he is revived, there is no force on earth that can keep me from his bedside.

Despite the fact that Mulder came within a single heartbeat of certain death, he's only on the ECMO for three days and the regular ventilator for two more. During this time he has to endure two more deep suction procedures to rid his airways of the bugs' carcasses. The massive doses of nicotine killed the bugs quickly and efficiently, but their remains have to be suctioned out before Mulder's body can even begin to oxygenate adequately. A rigid bronchoscopy is done to assess the devastation to his respiratory system. There is residual damage that only time will heal, but he begins to breathe on his own in an astonishingly short time.

His lung tissues, finally rid of the tobacco beetles, are scarred from the infestation and the measures used to save him. Even the ventilator leaves damage to the delicate lungs, and the wound in his neck from the ECMO has to heal. He'll need high doses of Albuteral and aerosol steroids like those asthma sufferers use, for a long time to come.

Now, in recovery, but still on a plastic nasal cannula for extra oxygen, Mulder looks wan and exhausted. The simple motions of breathing in and out so tiring that he sleeps most of the day after his extubation from the ventilator.

Breathing. An exercise so primal and necessary few of us ever think much about it even when we are doing it. Breathe in, breathe out. The simple movements of the thoracic muscles causes the lungs to expand and contract to draw life-giving oxygen into the body to feed the cells. An exchange of elemental gases. But for Mulder's damaged lungs it is an arduous process, actually painful. And so taxing, he burns precious calories with each  
inhalation. I can see that he's losing weight, the angular planes of his face gaunt and narrow.

There's no stopping him, though. He cons me into bringing him his laptop on the last day in Asheford Medical Center, to finish his notes on the case. He's sitting up in bed, glasses perched on his nose, fingers flying over the keyboard. But there's a sheen of sweat on his top lip and I can see the pronounced rise and fall of his chest through his T-shirt. His  
rib cage heaves as if he's been running around the track.

"Mulder, you need to take a break." I hold out a calorie laden chocolate malt invitingly. It'll be easy for him to get down, because when he's breathing so fast, even eating is  
difficult.

"Done, Scully." He shuts down the laptop and takes off the glasses, his eyes alight. "Y'think this could change the hold the tobacco lobby has on Congress?" His voice is raspy and coarse, still barely above a whisper and I wonder how long it will be before he can talk clearly.

"Eat this before it melts." I hand over the milkshake and he takes a few sips of the delicious dessert. "I certainly hope you didn't intentionally get infected as a gesture?" I ask horrified.

"Didn't know what I was getting myself into." He sucks air, panting from just talking, the milkshake cup dripping condensation onto the bed sheets.

"Thank goodness for that." I sit down on the side of the bed, pushing against his hip until he moves his long legs with a grin. "Although I wouldn't put it past you."

"Scully," he complains, then takes another drag on the milkshake straw before putting it down. "I didn't mean to scare you."

"You did, though." I rub my finger along the delicate bones of his hand, his skin scabbed and bruised from numerous blood draws and IV's. "You always do." I long to kiss him, my lips pressed against his, but we have an agreement about public displays of affection. Besides, I'm afraid it would rob him of a few precious molecules of oxygen.

 _Breathe in, Mulder, breathe out._

The respiratory therapist knocks softly before letting herself in, arms loaded with the drugs and paraphernalia of her profession.

Mulder flashes me a naughty smile, his eyes teasing, then releases my hand as the woman begins to hook up her equipment. "We'll be back home tomorrow," he promises, his husky voice surprisingly sexy.

I store the promise in my heart, stepping aside to let the R.T. do her job. Mulder looks rebellious when she hands him the first of three inhalers and I frown at him over the girl's shoulder. He takes a deep breath, his face tightening with the resulting pain and coughs. The therapist encourages him quietly and the second aerosol treatment goes more smoothly.

I'll hear his heavy, labored breathing in my sleep. It's a sweet sound and I'll cherish it as long as I live.

Breath. The essence of life. The exchange of the atmosphere's gases connects us to the Cosmos. Each person, animal and tiny cell that requires oxygen to live survives for  
one more second with each inspiration and exhalation. _Breathe, Mulder._ You are my inspiration, the element that keeps my cells alive.

My extra heart.

 

Fin.


End file.
